Mandatory generic prescribing is a very useful, practical and secure way to save money, avoid licensing corruption, end over-prescribing.
2bn euro per year is a lot of money.

In Greece, the amount of money saved could be much more, even if the Country has only a fraction of Spain's population.

This is because in Greece over-prescribing, under the counter deals, inefficient public healthcare management, and worse have existed for decades and have geometrically increased pharmaceutical expenditure. [1] [2] [3] [4] [5] [6] [7] [8] [9]

Greece is by far the first European Country in pharmaceutical expenditure per capita! [10] [11]

Last week the Ministry of Health working together with the Ministry of Social Welfare decided to copy this Spanish law. They changed plans the next day, after some meetings with officials working for Pharmaceutical Companies!

[2] Health Syst Transit. 2010 Nov;12(7):1-177. Greece health system review.
Economou C. Panteion University of Social and Political Sciences.
World Health Organization 2010, on behalf of the European Observatory on health systems and Policies.

Severe humanitarian crisis in Greece reported by major international journals

Dear Editors,

Major international journals have finally discovered and exposed the deplorable dangerous conditions of Greek public hospitals, healthcare humanitarian crisis that afflict the Greek population, the inability of Authorities to guarantee proper healthcare conditions, etc.

I started reporting these facts more than two years ago, in various sections of the BMJ.

Doctors uncaring is the cause of opioid problems today. For over 150 years the most prescribed pain medicine is morphine-despite opioids causing slepp apnea, overdose, mental fog, addiction. hormone problems-doctors and medicien have failed to come up with safer and more feffective medications and treatments- Dr Turk who was on the IOM study on pain indicated pills wont cure pain- and he indicated our best medicines are only 15 effective for pain. Less then 1% of the NIH budget goes for chronic pain research. In a study last year nurses were asked about barriers to pain care- 25% said its because doctors really dont care about peoples pain. In another study last year 70% of physicians indicated they are unable to diagnose pain. In another study 70% of physicians failed basic test of musculokeletal knowledge- 80% of pain is musculoskeletal. Not a single institute at NIH has as their goal lowering the prevalence of painful conditions. The prevalence of painful conditions has risen very rapidly over the past decades -with no vision or plan in medicine or government to energetically address such. Its clear tha neither government nor medicine care about the suffering or costs of chronic pain. We pay 4X as much per capita for pain as the EU-that certainly wasnt in the IOM report on pain. The IOM, government, and medicine want people to receive "treatments" for pain but are not concerned enough to see that people in pain have the benefit of doctors with education in pain care-and even the so called pain specialists are undereducated- a point which the AAPM was able to convince the AMA of -less then a few years ago. Everywhere you turn the negligence of government and medicine is apparent when it comes to pain care- the ones who pauy for such are not government or pain care-but people suffering pain and the rest of the public. The sorry state of affairs in pain care will continue until the government hears too much complaints from people in pain.

Dire means horrible, as in the consequences of action on or in view of the complacent.

I agree with Balko often enough but there's a parallel lexicon for the hyperbole of libertarians when they talk about government intervention and the hyperbole of liberals and conservatives when they talk about human behavior.

Much of the progress made by the civil rights movement during the 1960s has been effectively eroded. Drug prohibition and the selective enforcement of drug laws have become the successor system to Jim Crow. They selectively target people of color, removing them from civil society and then barring them from the right to vote.

Drug Prohibition is the primary factor in the destruction of African-American families and African-American communities.

A disproportionate percentage of African-Americans are being branded as felons. This effectively eliminates the chance of finding decent employment, and with it the possibility to successfully raise and support a family.

The following facts are indisputable:

* Our heavily militarized Police force is effectively laying siege to black neighborhoods. This is not happening with the same force and zeal in predominantly white neighborhoods.

* Afro-Americans are being stopped and searched at a far higher frequency than white Americans.

* Afro-Americans represent just 12.2 % of the population but are 37% of those arrested for drug offenses.

* Afro-Americans comprise 53% of drug convictions but are just 12.2% of the population.

* Afro-Americans comprise 67 percent of all people imprisoned for drug offenses but are just 12.2% of the population.

* One out of three young African American (ages 18 to 35) men are in prison or on some form of supervised release.

* There are more African American men in prison than in college. That's a four times higher percentage of Black men in prison than South Africa at the height of apartheid.

In July 2011 The NAACP passed an "historic" resolution, calling for an end to drug prohibition. Very soon, many other civic organizations, the entire faith community and all persons of good conscience will join the many who are already demanding that this horrific assault on the African-American community be halted immediately. What about YOU?

Whatever the exact dynamics involved, these racial disparities are a direct result of drug-prohibition and are quite clearly unacceptable. This dangerous and costly moronothon has done nothing but result in generations of incarcerated and disenfranchised Afro Americans. Any citizen not doing their utmost to help reverse this perverse injustice may duly hang their head in shame.

"The arc of the moral universe is long but it bends toward justice"
- Martin Luther King Jr

"If you are neutral in situations of injustice, you have chosen the side of the oppressor."
- Desmond Tutu

* Colombia, Peru, Mexico or Afghanistan with their coca leaves, marijuana buds or poppy sap are not igniting temptation in the minds of our weak, innocent citizens. These countries are duly responding to the enormous demand that comes from within our own borders. Invading or destroying these countries, thus creating more hate, violence, instability, injustice and corruption, will not fix our problem.

* A rather large majority of people will always feel the need to use drugs such as heroin, opium, nicotine, amphetamines, alcohol, sugar, or caffeine.

* The massive majority of adults who use drugs do so recreationally - getting high at the weekend then up for work on a Monday morning.

* Apart from the huge percentage of people addicted to both sugar and caffeine, a small minority of adults (5%) will always experience the use of other drugs as problematic. - approx. 3% are dependent on alcohol, and 1.5% dependent on other drugs.

* Just as it was impossible to prevent alcohol from being produced and used in the U.S. in the 1920s, so too, it is equally impossible to prevent any of the aforementioned drugs from being produced, distributed and widely used by those who desire to do so.

* Prohibition kills more people and ruins more lives than the drugs it prohibits.

* Due to Prohibition (historically proven to be an utter failure at every level), the availability of most of these mood-altering drugs has become so universal and unfettered that in any city of the civilized world, any one of us would be able to procure practically any drug we wish within an hour.

* Throughout history, the prohibition of any mind-altering substance has always exploded usage rates, overcrowded jails, fueled organized crime, created rampant corruption of law-enforcement - even whole governments, while inducing an incalculable amount of suffering and death.

* The involvement of the CIA in running Heroin from Vietnam, Southeast Asia and Afghanistan and Cocaine from Central America has been well documented by the 1989 Kerry Committee report, academic researchers Alfred McCoy and Peter Dale Scott, and the late journalist Gary Webb.

* It's not even possible to keep drugs out of prisons, but prohibitionists wish to waste trillions of dollars in an utterly futile attempt to keep them off our streets.

* The United States jails a larger percentage of it's own citizens than any other country in the world, including those run by the worst totalitarian regimes, yet it has far higher use/addiction rates than most other countries.

* Prohibition is the "Goose that laid the golden egg" and the lifeblood of terrorists as well as drug cartels. Both the Taliban and the terrorists of al Qaeda derive their main income from the prohibition-inflated value of the opium poppy. An estimated 44 % of the heroin produced in Afghanistan, with an estimated annual destination value of US $ 27 Billion, transits through Pakistan. Prohibition has essentially destroyed Pakistan's legal economy and social fabric. - We may be about to witness the planet's first civil war in a nation with nuclear capabilities. - Kindly Google: 'A GLOBAL OVERVIEW OF NARCOTICS-FUNDED TERRORIST GROUPS' Only those opposed, or willing to ignore these facts, want things the way they are.

* The future depends on whether or not enough of us are willing to take a long look at the tragic results of prohibition. If we continue to skirt the primary issue while refusing to address the root problem then we can expect no other result than a worsening of the current dire situation. - Good intentions, wishful thinking and pseudoscience are no match for the immutable realities of human nature.

* The urge to save humanity is almost always a false-face for the urge to rule it. - H. L. Mencken (1880-1956) American editor, essayist and philologist.

In addition to the many societal costs of prohibition, it has a long history of driving the spread of harder or more dangerous drugs.

* Poppies to morphine to heroine to krokodil
* Coca to cocaine to crack
* Ephedra to ephedrine to speed to methamphetamine
* Marijuana to skunk to dangerous synthetic concoctions such as 'spice' or 'bath salts'
* Mushrooms to ecstasy to 2CB/designers

At every step the reasons for the rise in popularity of the new form of the drug are one or more of the following:

* It may easier to smuggle.
* It may be more addictive, thus compelling the buyer to return more frequently.
* It may be cheaper to produce therefore yielding more profit.
* Like a game of "whack a mole" a shutdown of producers in one area will mean business opportunities for another set of producers with a similar product.

Prohibition's distortion of the immutable laws of 'supply and demand' subsidizes organized crime, foreign terrorists, corrupt cops & politicians and feeds the prejudices of self-appointed culture warriors. So called Tough-On-Drugs politicians have happily built careers on confusing drug prohibition's horrendous collateral damage with the substances that they claim to be fighting, while the big losers in this battle are everybody else, especially taxpayers.

How come so many of us have been deluded into believing that big government is the appropriate response to non-traditional consensual vices?

Imagine if we were to chop down every single tree on the planet as a response to our failure to prevent tree-climbing accidents. That's what our misguided drug policy looks like. Isn't it time we all stood up and told the government we're tired of being beaten and jailed so that pharmaceutical companies can poison and kill us for obscene profits?

"How come so many of us have been deluded into believing that big government is the appropriate response to non-traditional consensual vices?"

Because government isn't the problem. Government is the solution. All hail FDR! Regulation 4 life! Alcohol, drugs, guns, smoking, trans fats, light bulbs... our benevolent progressive overlords only have our best interests at heart.

"Imagine if we were to chop down every single tree on the planet as a response to our failure to prevent tree-climbing accidents."

Megan McArdle said today that making pseudoephedrine available by prescription only is like punching 15,000 in the head to save one life.

For a publication that has, in the past, admirably supported the legalization of drugs, the positon taken in this post is appalling. Nowhere in the Constituition does it give the government the right to regulate what we put in our bodies nor does it state that the gov't is empowered to protect us from ourselves. Better to eliminate all gov't controls over access to drugs, both recreational and prescription (with the likely exception of antibiotics due to the impact on their effectiveness of overuse). Insurance coverage would, however, only be provided with a doctor's prescription. If some people choose to use these drugs in a manner that results in their deaths, that is neither the gov't's nor my business and may actually result in a useful culling of the herd.

And neither does it say that we're not allowed to hang prohibitionist idiots up by their goolies!

Prohibition has finally run it's course. If you can't see that then you're smoking something far stronger than the rest of us.

It's rife with major failures and absurdities, from the rise of a vast, murderous narco-state within Mexico, to the ridiculous refusal by pious federal authorities to allow farmers to grow hemp--a useful, profitable, sustainable, and historic crop.

I have conflicted feelings about this. In the area where I grew up (Appalachian Ohio) pills seem like an increasingly serious problem. Poverty is very high and people tend to have a life of physically punishing work and federal/state assistance with health care when their spines or other joints explode. The area is literally awash in pharmaceuticals and they are readily available to nearly anyone. People get fairly generous subscriptions, and I can't really blame folks with little money for selling what they don't consume.

Heroin is the ultimate synthetic opiate. Opium is the only non-synthetic opiod, it is found in poppies. Opium is then modified to produce all of the synthetic derivitives. You could argue that the popppy also synthesizes the stuff, so opium is also, strictly speaking, synthetic, but we usually divide the world up into stuff that we make and everything else.

I believe the post phrases the issue slightly off: law enforcement is encroaching not because of pill mills but because the pills themselves are dangerous. The emphasis is different; it's not merely that pill mills exist but that the pills kill people. Large numbers of people.

And to agree with another commenter, pot is shown to have very few bad effects. The latest is that pot doesn't even constrict breathing, that regular use of pot below the level of "heavy user", had a positive effect on lung function. Cigarettes, by contrast, materially constricted lung function.

You miss the point- why do doctors continue to use dangerous medications that dont cure pain but make pain sufferers hostage to dangerous and ineffective medications? Its clear morphine is the most prescribed pain medication for more then a century- so why doesnt lazy medicine and lazy government come up with better treatments? They really dont care about people in pain-thats the answer.

End the Military Aggression, eXcessive Incarceration, and Police Action on Drugs AKA MAXI PAD! It's bloody and there are better alternatives according to Tobacco, Alcohol, Meth, and Pharmaceutical Addiction eXperts.

Oh please- if the cdc was really concerned with painkillers they ask the president to come up with better medications then opioids-after all opioids have been in use for over 2500 years- you think in the postgenomic era our genius medical system would come up with safer more effective treatments? But of course the problem of opioids is a red herring representing the moral and menal laziness both government and medicine has toward people in pain. The doctors fight against having any education in pain care- a study last year showed they know all of three medications for pain. And government is captured by the intersts of medicine and refuses to serve recognize the needs of people in pain. They have no vision to lower the prevealence of pain. The CD lke the rest of government continues to fiddle while people in pain burn. Their so called concerns ring false given their lack of vision and refusal to address the sad truths about pain care that medicine has a history of not caring about people in pain and government just goes along with what medicine wants- i challenge any one in government or medicine to debate me publically on this issue-but lazy cowards arent my match

I disagree- neurochemistry is a figment of economic policy. If our scientists werent working so hard to help the profits of drug companies and were more focused on objective research-then perhaps neurochemistry would be very different then it is today. Its easy for some people to accept the status quo as the natural order of things -harder to objectively challenge it and break ones head open to create the symbols of a new day

"if the cdc was really concerned with painkillers they ask the president to come up with better medications then opioids"
The CDC can ask the President to come up with medical breakthroughs, and then it just happens magically after?
Oh my God, why didn't we think of this before? The CDC should also ask the President to come up with the cure for cancer, AIDS, asthma, and the common cold! How could they not have thought of that before?!?!?!
"-after all opioids have been in use for over 2500 years- you think in the postgenomic era our genius medical system would come up with safer more effective treatments?"
Actually, medical science has come up with safer and more effective treatments for pain than the consumption of strained poppy plants. Go buy a textbook on anesthesia and analgesia if you're truly interested. I guarantee you that any textbook consists of more than the sentence, "For pain, use the same recipe of strained poppy plants that people used 2500 years ago."
"But of course the problem of opioids is a red herring representing the moral and menal laziness both government and medicine has toward people in pain."
There are pain specialists, researchers, and treatment centers, billions of dollars spent....
"The doctors fight against having any education in pain care- a study last year showed they know all of three medications for pain."
That's because for the average primary care doctor, if he can't take care of the pain using non-steroidal anti-inflammatory drugs (NSAIDs) or other common treatments, it's best to refer the person to a specialist because the other drugs carry side effects requiring specific monitoring and new research is continually being published. Only a specialist can be reasonably expected to be up to date on all of the newest treatments, their benefits and risks, etc.
"And government is captured by the intersts of medicine and refuses to serve recognize the needs of people in pain. They have no vision to lower the prevealence of pain. The CD lke the rest of government continues to fiddle while people in pain burn. Their so called concerns ring false given their lack of vision and refusal to address the sad truths about pain care that medicine has a history of not caring about people in pain and government just goes along with what medicine wants- i challenge any one in government or medicine to debate me publically on this issue-but lazy cowards arent my match"
There's no profit in ignoring people with a chronic medical condition. On the contrary - drugs that treat hypertension, high cholesterol, diabetes, etc. are considered "blockbuster" drugs because millions of people have those conditions and they require long-term treatment. That translates to $$$$$$, which Big Pharma likes.
Pain is a long-term condition that millions of people have. Ergo, there's a lot of money to be made in treating it. Hence the researchers and specialists I mentioned earlier. However, just because modern medical science hasn't found a cure for something doesn't mean the healthcare industry isn't trying. You don't think there are hundreds of thousands of scientists right now who would love to go down in history as the guy who cured cancer? You don't think there are thousands of firms who want to patent that cure? Yet, with all of that desire to cure it and government support, people are still dying from cancer every day.
Trying reading about economics and the field of pain medicine before you accuse people who are actually working on this problem of being lazy cowards.

So much for the received view that shields both government and medical science from taking pain seriously
Since doctors are most likely to see someone in pain- as pain is the main reason people seek medical care- its indefensible and unporfessional to suggest doctors should continue to have no education in pain care. And its negligent entrustment to allow swaggering and ignorant and uncaring doctors to continue to neglect people in pain and cause over $650 billion to the U.S. annually- and the costs rise rapidly as ignorant and uncaring doctors refuse to care or learn anything about paib.
Your average textbook on Anesthesia or Interventional Pain Medicine is riddled with linear medicine and moreover reflects the lack of knowledge of disciplines like ostopathy, psychology, chiropractic, orthopedics- to name a few. Pehaps instead of sleeping on Bonicas Pain Managemnet- you should learn something about pain from more diverse sources.
Its interesting Senator Spectre in the recent past found that there were roadblocks to curative treatments at NIH and in the June 2011 IOM report on pain they clearly state they dont beleive in cures. They arent really trying either. Research shows that approximately 15% of people with rheumatoid arthritis become pain free- wheres the study that studies how they did it? How bout migraine- 15% also becopme migraine free-no study on how these 15% did it. We know patent foramen oval surgery works for some- but as Story Landis has pointed out - shes on the NIH pain consortium trerwatments for pain are "woefully inadequate" The massive failure to assess and treat pain as the Texas Pain Initiative report indicates is due to the fact not treating pain doesnt come with a cost to doctors- the cost is born by those suffering pain and their families.
Some people like to believe in fairytales when it comes to medicine in pain care instead of examine the facts- the facts are pain has long been neglected by medicine and reports after report point to doctors not caring, belittling people in pain- even the Federal Governemtn asked the IOM to study pain due to pain being underresearched, underdiagnosed and undertreated

There is a movement in pain management that is just beginning, being advanced by Dr John Lyftogt from New Zealand in treating neuropathic pain that targets the source of pain. It targets the peripheral nervous system, specifically TRPV1 receptors that are found in unmyelinated C fibers.It is very effective, economical and safe. The opiates, anticonvulsants and antidepressants are the only currently available FDA approved treatments, target the 3rd order neurons (brain), which are modulators to the incoming pain activity and dampen our experience of pain. These CNS medications are not very effective , not easily tolerated and are associated with adverse side effects including dizziness addiction. i hope that doctors and our government will discover this and join our search for better outcomes for our patients in pain.

... it's more than possible to OD on cannabis. It's just not fatal. I recall the account of someone who, in the mistaken belief that he was "stealing" a plate of fresh baked goods, instead consumed a heroic amount of hash brownies, and proceeded to spend the next week in a hospital, vividly hallucinating.

That "no one has ever overdosed on cannabis" is a common myth propagated by pro-legalization organizations. I'm all for marijuana legalization but let's not make it something it's not.

I'd like to jump in and do the whole, "You can trust me because I'm an anonymous guy on the internet claiming to be a doctor."

You're both right. Seize_the_diem is correct that it's damn near impossible to consume enough hashish or smoke enough marijuana to kill yourself. Heroin and (perfectly legal) alcohol can be consumed at levels toxic enough to kill (look up "heroin overdose" and "alcohol poisoning") but marijuana can't.

However, as Ah Beng noted, extremely high levels of cannabis can cause prolonged or severe symptoms. People who are experiencing altered mental status, paranoia, anxiety, or delays reaction time are at risk of hurting themselves and others (e.g. if they decide to drive someplace). And in that example, "overdosing" on marijuana is more dangerous than eating too much steak and ribs...

I'm all for legalization of marijuana, but while the dangers of marijuana are most certainly overblown especially by people who are comfortable with mind-altering-and-physically-addicting alcohol and carcinogenic-and-asthma-exacerbating tobacco being legal, it's important to not belittle the effects of marijuana use as akin to pigging out on barbecue.